Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients.

Huber, Wolfgang; Mayr, Uli; Umgelter, Andreas; Franzen, Michael; Reindl, Wolfgang; Schmid, Roland M; Eckel, Florian

doi:10.1631/jzus.B1700243

journal article

Titel:: Mandatory criteria for the application of variability-based parameters of fluid responsiveness: a prospective study in different groups of ICU patients.
Dokumenttyp:: Article; Journal Article
Autor(en):: Huber, Wolfgang; Mayr, Uli; Umgelter, Andreas; Franzen, Michael; Reindl, Wolfgang; Schmid, Roland M; Eckel, Florian
Abstract:: BACKGROUND AND OBJECTIVE: Stroke volume variation (SVV) has high sensitivity and specificity in predicting fluid responsiveness. However, sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for their application. Several studies suggest a limited applicability of SVV in intensive care unit (ICU) patients. We hypothesized that the applicability of SVV might be different over time and within certain subgroups of ICU patients. Therefore, we analysed the prevalence of SR and CV in ICU patients during the first 24 h of PiCCO-monitoring (primary endpoint) and during the total ICU stay. We also investigated the applicability of SVV in the subgroups of patients with sepsis, cirrhosis, and acute pancreatitis. METHODS: The prevalence of SR and CV was documented immediately before 1241 thermodilution measurements in 88 patients. RESULTS: In all measurements, SVV was applicable in about 24%. However, the applicability of SVV was time-dependent: the prevalence of both SR and CV was higher during the first 24 h compared to measurements thereafter (36.1% vs. 21.9%; P<0.001). Within different subgroups, the applicability during the first 24 h of monitoring ranged between 0% in acute pancreatitis, 25.5% in liver failure, and 48.9% in patients without pancreatitis, liver failure, pneumonia or sepsis. CONCLUSIONS: The applicability of SVV in a predominantly medical ICU is only about 25%-35%. The prevalence of both mandatory criteria decreases over time during the ICU stay. Furthermore, the applicability is particularly low in patients with acute pancreatitis and liver failure.
Zeitschriftentitel:: J Zhejiang Univ Sci B
Jahr:: 2018
Band / Volume:: 19
Heft / Issue:: 7
Seitenangaben Beitrag:: 515-524
Volltext / DOI:: doi:10.1631/jzus.B1700243
PubMed:: http://view.ncbi.nlm.nih.gov/pubmed/29971990
Print-ISSN:: 1673-1581
TUM Einrichtung:: II. Medizinische Klinik und Poliklinik (Gastroenterologie)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Klinik und Poliklinik für Innere Medizin II, Gastroenterologie (Prof. Schmid)2018